Chris Hannah, chief executive of Cheshire and Merseyside Strategic Health Authority (SHA), said: "Our proposals are designed to ensure we have organisations fit for purpose to deliver a patient-led NHS.

"Commissioners - currently PCTs but in future GP practices - determine the health needs to be met and ensure they meet them in the most effective way, based on their knowledge of local communities.

"GP practices will ultimately lead commissioning supported by bigger and stronger PCTs who will negotiate agreements with a range of providers, including the independent sector.

"GP practices are best placed to determine the needs of local people so it makes sense for commissioning decisions to be with them."

In July, the Government published a white paper, Commissioning a Patient-Led NHS, requiring SHAs to strengthen commissioning arrangements and release #250m nationally through savings in overheads.

Mr Hannah added: "Every aspect will be subject to extensive public consultation, ensuring that patients and the public have a say in shaping their local NHS.

"This will begin in December and we will be releasing full details in the coming weeks."

North, South and Central Liverpool PCTs replaced Liverpool Health Authority in April 2002 following a 10-week consultation.

It was felt three smaller organisations would be able to reach out to communities better and provide more focused health care.

The new proposals could effectively return the organisational structure to one similar to 2002.

A ballot of 250 Liverpool GPs in 2001 showed 57% supported the move to three PCTs, so a remerger may not be popular among them.

But it would be welcomed by Liverpool City Council, which is generally frustrated by having to work with three front-line health providers instead of just one.